The feasibility and efficacy of transjugular intrahepatic portosystemic shunts (TIPS) were evaluated in 10 patients with preexisting portal vein occlusions. A standard transjugular approach was used in six of the 10 patients for both portal vein recanalization and TIPS placement. The protal veins were successfully recanalized and TIPS were established in three of the six patients. TIPS placement was unsuccessful in the other three patients because the catheters could not be advanced through the occluded segments. A transhepatic approach was used in four of the 10 patients for portal vein recanalization before transjugular catheterization and TIPS placement were attempted. Both portal vein recanalization and TIPS placement were technically successful in all four patients. Bleeding stopped in all patients after successful shunt placement. TIPS can be used to control variceal bleeding in some patients, despite preexisting portal vein occlusion. Preliminary recanalization of the occluded portal segment by means of the transhepatic approach may facilitate TIPS placement.